The following is a summary of “Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis,” published in the September 2023 issue of Pain and Symptom Management by Gonella, et al.
It is still being determined whether and how the availability of interventions designed to encourage end-of-life talks affects the delivery of end-of-life conversations even though such interventions are readily available. Measuring the steps taken to provide compassionate end-of-life care can motivate change. The goal of this study is to provide an estimate of the influence of interventions designed to encourage end-of-life conversations on process markers of end-of-life conversations during clinical encounters with patients who have advanced chronic or terminal illness or their families.
Meta-analysis based on a systematic review (CRD42021289471, PROSPERO). Until September 30, 2021, PubMed, CINAHL, PsycINFO, and Scopus were combined to find relevant articles. Indicators of progress made in having these talks were the significant outcomes. The occurrence meta-analysis results were given as a Risk Ratio (RR), the quality meta-analysis results as a Standardized Mean Difference (SMD), and the duration meta-analysis results as a Ratio of Means (ROM). When there were less than four studies, a meta-analysis was not conducted. There were a whopping 4,663 articles analyzed. There were a total of eighteen studies included in the systematic review, and 16 of those studies participated in at least one meta-analysis (n = 8 for documented occurrence, n = 4 for patient-reported occurrence, n = 4 for patient-reported quality, n = 4 for duration).
The venues, clinical situations, and specialists involved all varied widely. Neither the documented rate of end-of-life conversations (RR 1.54, 95% CI 0.84-2.84; I2 91%) nor the patient-reported rate of end-of-life conversations (RR 1.52, 95% CI 0.80-2.91; I2 95%), the quality of end-of-life conversations as reported by patients (SMD 0.83, 95% CI 1.06 to 2.71; I2 99%), nor their duration (ROM 1.20, 95% CI 0. Inconsistent frequency data was available. Early and in-depth dialogues were facilitated via interventions that targeted various parties. Even though there was a wide range of results, treatments had no discernible impact on the frequency, perceived quality, or length of end-of-life talks. However, researchers did find evidence that interventions aimed at a wide range of parties could help stimulate talks that are both more timely and more comprehensive.
Source: sciencedirect.com/science/article/abs/pii/S0885392423005055
